Second Opinion: MUCH to think about ...

Monday - September 24, 2012

Today is the second opinion on the Bone Marrow Transplant:  autologous or allogeneic, that's the queston ....  Megan, Joe, and I are taking a quick daytrip up to Baltimore.  I am hoping that this different perspective and our subsequent discussion will give me more comfort and peace in determining - if given a choice - which route to take.

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Another 11.5 hour medical day with Joe ably driving us roundtrip to Baltimore (as well as finding us a fabulous Indian buffet lunch)...  It was a long day which has left us all with much to contemplate.  No surprises per se -- simply discussion, clarification, and vetting of options.  Our meeting was very thorough:  first with the nurse practitioner and then the transplant surgeon/ specialist.  All together, we were at Greenebaum for 3.5 hours.  I felt that my case was completely reviewed and considered and that the physician was attentive to my concerns and questions.  I was very impressed and reassured by him and the manner in which he approached our consultation.

All that being said, there is no getting around the fact that my situation is quite serious.  In the immediacy of my chemo treatments, I think I often push away the fact that this lymphoma is aggressive and was widely dispersed before it was finally diagnosed in May.  These bone marrow transplant consultations require me to face the hard data squarely.  A full day of reading, listening, and discussing mortality numbers, relapse probabilities, and survival rates is difficult but absolutely necessary to make an informed decision which gives me the best long-term outcome.

While I am still digesting the details of the meeting, our consensus is that we will pursue an allogeneic (third party donor) BMT.  An autologous BMT carries a high probability of relapse and salvage therapies are more problematic given the high-intensity of my current Hyper-CVAD protocol.  Essentially, we have played our strongest cards with this initial chemo and these drugs will have limited efficacy in case of relapse.  We have used the best tools on the chemo shelf and need to knock out any possible remaining lymphoma with an allogeneic BMT while I am in this current period of "complete response." 

More later as I absorb the specifics but it was a highly worthwhile trip, a nurturing consultation, and much food for thought is now addling my brain.